January/February 2015
JOURNAL A silent struggle Nurses looking for help to overcome substance use want a dedicated program to address their needs.
Under 65 and in long-term care • RNAO marks 90 years • Teens helping teens
C al ra On l u te ta s t s d rio o ro a fin p ut d pin o ou g tm ! or e!
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Vol. 27, No. 1, January/February 2015
contents Features
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22
12 COVER STORY Road to recovery Each year, one in five Canadians will experience a mental health or addiction problem. Nurses represented in these stats are calling for dedicated help that addresses their unique needs. By Melissa Di Costanzo
18 A lifetime in long-term care Michael Wedemeyer, 24, is among thousands of young Ontarians who live in long-term care because there’s nowhere else to go. By Daniel Punch
22 Strengthening youth mental health A unique RNAO partnership with six Ontario public-health units is helping teens help teens. By Melissa Di Costanzo
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24 RNAO’s 90th anniversary In this issue, we explore the association’s work on diversity and inclusivity. By Kimberley Kearsey
the lineup 4 Editor’s Note 5 President’s View 6 CEO Dispatch 7 RN Profile 8 Nursing in the News 11 Nursing Notes 17 Policy at Work 30 In the End
Cover Photo: Marcy Maloy/Getty Images
Registered nurse journal
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The journal of the REGISTERED NURSES’ ASSOCIATION OF ONTARIO (RNAO) 158 Pearl Street Toronto ON, M5H 1L3 Phone: 416-599-1925 Toll-Free: 1-800-268-7199 Fax: 416-599-1926 Website: www.rnao.ca Email: editor@rnao.ca Letters to the editor: letters@rnao.ca EDITORIAL STAFF Marion Zych, Publisher Kimberley Kearsey, Managing Editor Melissa Di Costanzo, Writer Daniel Punch, Editorial Assistant
Editor’s Note Kimberley Kearsey
The art of storytelling
EDITORIAL ADVISORY COMMITTEE Chris Aagaard, Shelly Archibald, Marianne Cochrane, Rebecca Harbridge, Paula Manuel, Melanie McEwan, Sandy Oliver Art DIRECTION & Design Fresh Art & Design Inc. ADVERTISING Registered Nurses’ Association of Ontario Phone: 416-599-1925 Fax: 416-599-1926 SUBSCRIPTIONS Registered Nurse Journal, ISSN 1484-0863, is a benefit to members of the RNAO. Paid subscriptions are welcome. Full subscription prices for one year (six issues), including taxes: Canada $38 (HST); Outside Canada: $45. Printed with vegetable-based inks on recycled paper (50 per cent recycled and 20 per cent post-consumer fibre) on acid-free paper. Registered Nurse Journal is published six times a year by RNAO. The views or opinions expressed in the editorials, articles or advertisements are those of the authors/advertisers and do not necessarily represent the policies of RNAO or the Editorial Advisory Committee. RNAO assumes no responsibility or liability for damages arising from any error or omission or from the use of any information or advice contained in the Registered Nurse Journal including editorials, studies, reports, letters and advertisements. All articles and photos accepted for publication become the property of RNAO. Indexed in Cumulative Index to Nursing and Allied Health Literature. CANADIAN POSTMASTER Undeliverable copies and change of address to: RNAO, 158 Pearl Street, Toronto ON, M5H 1L3. Publications Mail Agreement No. 40006768. RNAO OFFICERS AND SENIOR MANAGEMENT Vanessa Burkoski, RN, BScN, MScN, DHA President, ext. 502 Rhonda Seidman-Carlson, RN, MN Immediate Past-President, ext. 504 Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT Chief Executive Officer, ext. 206 Daniel Lau, MBA Director, Membership and Services, ext. 218 Irmajean Bajnok, RN, MScN, PhD Director, International Affairs and Best Practice Guidelines Centre, ext. 234 Marion Zych, BA, Journalism, BA, Political Science Director, Communications, ext. 209 Nancy Campbell, MBA Director, Finance and Administration, ext. 229
i love telling stories. good. bad.
Funny. Ironic. Shocking. I think I get this from my dad. “You tell the story, Al,” is a common refrain from my mother when there’s news to share. She knows how well he builds suspense and captures details, so she leaves most of the “telling” to him. I’d like to think I possess that same unique skill that enamours so many people to my dad, but I don’t think I’m all that different from others who just know a good story when they hear it. There’s a definite feeling of vulnerability when you share personal details of your life and experiences with the public. If your tale is funny, will people laugh? If it’s sad, will they empathize? These are good questions, but if a story is worth telling, it will be well-received, regardless of the emotion it conjures up. Some stories are difficult to tell. And, in this issue, we bring you two nurses who have overcome challenges with substance use (page 12). This is one of those “hard” stories, but it’s a “good” one because it helps to bring addiction out of the shadows. We also shed light on
another troubling narrative that is playing out in long-term care homes across the province (page 18). As the number of younger individuals in long-term care homes rises, so too do nurses’ concerns they are not able to provide the care these residents need and deserve. As we start a new year, we bring you the first in a series of features to celebrate RNAO’s 90th anniversary. We look at the work of the association on diversity and inclusivity (page 24). We will continue to mark the 90th in each issue, and are once again looking to members to share personal anecdotes that will help to bring our coverage to life (page 28). Is there an RNAO initiative that has made you proud to be a member? Do you have a fond memory of RNAO? I bet you do. Nurses are full of great stories. And I’m looking forward to reading them because a collection will be chosen for publication in our July/August issue. Compelling content on these pages comes from you. And we thank you for that. Please keep the stories coming. RN
Louis-Charles Lavallée, CMC, MBA Director, Information Management and Technology, ext. 264
RNJ Is now
DIGITAL! 4
January/February 2015
As a member, you are eligible to receive a digital copy of Registered Nurse Journal. You can choose to receive only an electronic version of the magazine by emailing info@RNAO.ca and stating your preference for a paperless version. If you haven’t received the magazine electronically, please let us know by contacting editor@RNAO.ca
president’s view with vanessa burkoski
Mentorship creates cycle of success
I am always moved by the stories of students and their amazing experiences on the journey to becoming RNs. As a student, I remember seeking out mentors who could help me grow and develop as a nurse. One of the best mentors I had was a seasoned public health nurse who talked to me a lot about my passion for nursing. I remember how she made me feel like I could change the world. More than anything, she taught me to be fearless in my convictions and to embrace my values. She constantly asked me: “What really matters most to you?” And depending on the answer to that question, she always pushed me to act on what mattered, and helped me map out a plan to get there. Throughout my nursing career, whether I’ve worked in direct care, management, or administration, I have enjoyed the benefit of close ties with a few key mentors. I know I can rely on them to coach me through new or challenging experiences. I have to admit that even after almost 32 years in the profession – and in very demanding roles over the decades – there are situations during which I could still benefit from a kind word or some guidance from timeto-time. We all can. Whether you are fresh out of nursing school, an RN who has just been promoted to charge nurse, or a seasoned registered
nurse who has moved from acute care to primary care: a little help goes a long way. Mentoring is about guiding, teaching, and, very simply, helping others. We all have the capacity to mentor. In fact, I believe that many conversations during a nursing shift provide an opportunity to share what we
model. I have served in all of these roles at one time or another. Many years ago, I committed to formally mentoring at least one student every year. I have lived up to that commitment for the past 18 years. When I was Ontario’s Provincial Chief Nursing Officer, I mentored two master’s students
“ it doesn’t matter what setting you work in, or what stage you are at in your career; we all have something to give. and by mentoring others, we create a cycle of success for everyone.” know and to support and inspire others. Mentoring is also about opening up possibilities for people so that they can identify their strengths or weaknesses and work on them. Recognizing challenges can often help people overcome them. Being a mentor can take many different forms, such as advisor, listener, resource person, confidante, strategist, sounding board, and role
from the University of Toronto. And, in my current role as chief nurse executive at London Health Sciences Centre, I act as a mentor for another master’s student from York University. Mentoring doesn’t always have to be formal. Recently, a peer reached out to me for help with a problem she was trying to solve. During our conversation, I realized she was lacking evidence-based information. I gave
her the information she needed and showed her an alternate approach that I thought was effective when I was dealing with a similar problem. The desire to learn – and the commitment to mentor others – has helped to shape the satisfying career I enjoy today. And one of the most important things I have learned as a mentor is that giving, without expectation about receiving in return, has earned me the trust and support of many people. I have also learned that it is a two-way street. Mentors can also benefit from the advice and direction they give to colleagues. As you read this issue of the Journal, and learn about how other members are sharing their experiences and wisdom with colleagues and nursing students alike, I ask you to do the same in your own practice. Ask yourself: How can I be a mentor? It doesn’t matter what setting you work in, or what stage you are at in your career; we all have something to give. And by mentoring others, we create a cycle of success for everyone. RN vanessa burkoski, rn, bscn, mscn, dha, is president of rnao.
RNAO offers unique mentorship opportunity through Advanced Clinical Practice Fellowships (ACPF) Interested in a focused, self-directed learning experience? Consider RNAO’s ACPF to develop clinical, leadership or BPG implementation knowledge and skills. With support from a mentor(s), your employer, and
RNAO, you can submit a proposal for an ACPF in one of six focus areas: emergency care, gerontology, home care, mental health, primary care, and marginalized populations.
Next request for proposals: March 2 Submission deadline: May 20 Find out more about the program and proposal-writing webinars at www.RNAO.ca/BPG/ get-involved/ACPF
Registered nurse journal
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CEO Dispatch with Doris Grinspun
Defending refugee claimant rights: Defending our core Canadian values
In december, rnao was granted intervener status in an appeal that will determine whether changes to federal health-care funding for refugee claimants are legal. Prime Minister Stephen Harper announced modifications to the Interim Federal Health Program (IFHP) in 2012 that effectively left refugee claimants and their families without access to primary care. In 2014, the federal government’s changes were deemed by a federal judge to be “cruel and unusual” treatment that could potentially put “lives at risk.” Allowing refugees access to health care goes to the very core of our country’s social fabric. RNAO and its members have adamantly advocated for health care as a basic human right. Denying an individual that right – based solely on their status in this country and not on their need for care – is a violation that RNAO has fought to reverse since the changes to IFHP came into effect almost three years ago. Our courageous, valuesdriven, and evidence-based advocacy has paid off. Intervener status at the Federal Court of Appeal is a true reflection of what it means to take on an issue, and to stick with it until we see success. I am so proud of RNAO’s members and board for our clear moral compass, unending passion for justice, and commitment to reverse this inhumane government decision. Members began contacting RNAO when they became 6
January/February 2015
aware of the changes to IFHP, and started to see first-hand the effects the cuts were having on their patients. On the pages of this Journal, we featured your stories about patients who were being denied: prenatal care; diabetes, asthma, epileptic or psychiatric medications; monitoring for heart disease; specialist care for sickle cell anemia; mental health care; and more (see Sept/Oct 2012, New country, no care).
forms of persecution come to Canada in search of hope and opportunity. If they are refused health care, we are not easing their suffering. The anger at seeing refugee claimants being treated as second-class citizens is palpable in the nursing community and beyond. And that’s what prompted so many of us to join forces with other concerned citizens to vocally oppose the changes at rallies and days-of-action across the
“ rns, nps and nursing students are incensed by the federal government’s claim the changes to ifhp will save money. as nurses, we know preventive care is less expensive than acute and urgent care.” RNs, NPs and nursing students are incensed by the federal government’s claim the changes to IFHP will save money. As nurses, we know preventive care is less expensive than acute and urgent care. Indeed, a study released last year by Toronto’s Hospital for Sick Children (SickKids) substantiated this fact with telling statistics that show, before the government cuts, only 6.4 per cent of refugee children visiting the SickKids ER had to be admitted. After the cuts, the admission rate doubled to 12 per cent. People who have escaped war, starvation, torture, and other
province and the country. Close to 3,000 of you joined RNAO by sending letters to Prime Minister Harper. RNAO issued media releases and action alerts to persuade him to change his mind. We brought a resolution to the Canadian Nurses Association that was unanimously passed in June 2012. And we joined forces with other health professionals who had their own front-line stories about how the changes were having a negative impact on patients and families. Ontario refugees’ rights were partially restored in January 2014, when the provincial
government launched the Ontario Temporary Health Program (OTHP) to provide primary care, acute care and some medical coverage for select refugee claimants. Kudos to then Health Minister Deb Matthews, who thanked RNAO and nurses for their advocacy, suggesting the provincial government felt just as strongly as nurses that denying health care to refugees was not the right thing to do. In November 2014, the federal government was forced to backtrack after Justice Anne Mactavish struck down the changes to IFHP four months earlier. The prime minister appealed Mactavish’s July ruling, and that’s why RNAO teamed up with the Canadian Association of Community Health Centres (CACHC) to apply for intervener status. I thank you all for your unwavering advocacy on this issue. Without it, the views of nurses would not be heard in the legal arguments that will be presented before the court by RNAO-CACHC legal counsel Rahool Agarwal and his team. We may not know exactly when the Federal Court of Appeal will hear this case, but I have every confidence the vindictive and counter-productive action of the federal government against refugee claimants will be exposed for what it really is: an affront to Canadian values. RN doris grinspun, rn, msn, phd, lld (hon), o.ont, is chief executive officer of rnao.
RN Profile
By Melissa Di Costanzo
At work...and play London RN engages teens through techniques – and technologies – that intrigue the young mind.
Christine garinger was 13-yearsold when her older brother began experimenting with drugs and alcohol. Then, he became delusional, and shared fantastical stories about belonging to a New York City gang. “I can remember thinking ‘something is really, really wrong here,’” the London RN recalls. She and her mother – who was a medical-surgical RN – listened helplessly as health professionals tried to wrestle with a diagnosis. It came (schizophrenia) amid aggressive and repeated visits from police to take her brother, then 16, into custody after a string of psychotic episodes. She pleaded with the police, explaining: He’s experiencing things that aren’t real. He’s not going to hurt you; he just doesn’t understand what’s happening, and he’s scared. Freshly enrolled in Fanshawe College’s three-year nursing diploma program (thanks to a push from mom), Garinger sent a letter to London Police Services. She urged officers to recognize that police need more training when it comes to approaching individuals with mental-health issues. “Ignorance breeds fear, and police officers need education,” she wrote. “I was watching (my brother) fall between the cracks,” and being taken in for treatment a number of times against his will, she explains. Given her personal experience, mental health may have seemed an inevitable choice for
talk to them,” she says, noting this RN. “I felt comfortable in that it “…became clear to me I that milieu,” she admits. But belong in…mental health.” RealGaringer didn’t discover until izing she needed to return to the later in her career that mental health is where she belongs. She path she was on, she moved to Calgary’s Foothills Hospital on graduated in 1994, determined to find a job in pediatrics, and moved out west in the middle of a hiring freeze. Garinger worked to make ends meet until finally accepting an RN position at Wood’s Homes, a mental-health centre in Calgary. She accepted the position – working with youth in crisis – out of sheer necessity, but ended up staying on as campus nurse for five years. Garinger nabbed teens’ attention through play. Games like Jenga are messy and noisy and a bit destructive, so they’re perfect for tumultuous teenagers, she says. She also scoured the Internet and hit the library to find more resources that “spoke to them, that were Three things you relevant to their lives. They don’t know about needed to connect with the Christine Garinger: material,” she explains, or 1. She went bungee jumping once, she just wouldn’t be able and doesn’t intend to do it again. to reach them. 2. She loves attending indie rock Fearful she was losing concerts with her husband. her bedside nursing skills, 3. She enjoys exploring libraries, Garinger signed up for and her favourite is the New York refresher courses and Public Library. accepted a position on a the adolescent inpatient unit. surgical pediatric unit at the By then, Garinger had two Alberta Children’s Hospital. boys of her own, and the Constantly rushed to complete family was ready to move back tasks, she quickly felt like a to Ontario. Garinger secured fish out of water. “I’d look at the distress on par- work at Newmarket’s Southlake Regional Health Centre’s ents’ faces and want to stop to
adolescent crisis unit. Eight months later, she moved to Regional Mental Health Care London (St. Joseph’s Health Care London) for a position on the adolescent inpatient unit, then became a crisis counsellor in the ER and community. In 2008, Garinger began working at mindyourmind, a non-profit mental-health program for youth and a partner in RNAO’s new youth mental health initiative (see pg. 22). She contributes clinical insight to the development of technology, such as an app like Be Safe, which helps youth make decisions in times of crisis. “That’s initially what drew me there,” she explains of providing the right information that has been adapted to teens’ needs. Without that kind of focused help, “…they’re not going to be able to take it in.” This is a lesson she’s learned throughout her career, and in her personal life. Her brother, who is now living on his own, listens to heavy metal and occasionally helps their mother care for the family cats. “He’s found the right equation, and the best quality of life for him(self),” she says. “I can’t make him feel better, and I can’t make him accept treatment or live in a particular way, but I’ve always wanted him just to know I care.” RN melissa di costanzo is staff writer at rnao. Registered nurse journal
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RNAO & RNs weigh in on…
nursing in th
Photo: Tara Walton/GetStock.com
Street nurses renew call for more shelter space With winter in full force, anti-poverty advocates are once again concerned there aren’t enough shelter beds to keep Ontario’s most vulnerable safe and out of the cold. This issue made headlines in Toronto in January when a homeless man died shortly after he was found unconscious at a downtown bus stop. He was wearing only a T-shirt and jeans in sub-freezing temperatures. “When I heard this...I was appalled and sickened,” Street Health nurse Joyce Rankin told CBC Radio’s Metro Morning, noting that similar incidents occur every winter. “How much does this have to happen before people sit up and take notice?” Some politicians claim Toronto has enough shelter beds, but Rankin says that’s impossible when the city must rely on Street Health’s Out of the Cold program, which provides food and shelter services for Toronto’s homeless. The proof is there, Rankin says, and it’s time for action. “I don’t want to see any more debate. I want to hear that they’re going to (make) a concer ted effor t to get shelter for people.” (Jan. 6) The freezing Toronto streets are particularly unsafe for the city’s homeless and marginally housed women, Rankin’s Street Health co-worker Jessica Hales told the Toronto Star. This population, which includes sex workers and those with substance-use and mental-health issues, are at a high risk of physical and sexual abuse on the street. Use of all of the city’s 600 shelter beds for women is contingent on a 9 p.m. curfew. Activists have been pressuring the city to open a 24-hour drop-in women’s shelter for the past two years, but city staff say there is no money in the budget for the initiative. “It’s hard when you are seeing women every day who have been assaulted or who don’t have a place to go,” Hales says. (Jan. 8)
Hundreds receive hepatitis A vaccination after cook found to be infected Staff at a Guelph-area health unit undertook one of the region’s largest vaccination actions in recent memory after a cook at a popular local restaurant was found to have hepatitis A. WellingtonDufferin-Guelph Public Health issued a vaccination advisory 8
January/February 2015
to anyone who ate at Marj’s Village Kitchen, a diner just north of Elora, over a two-anda-half-week span. The advisory was issued on Jan. 22, and by Jan. 26, about 1,400 people had received their shot. As of Jan. 26, no resulting cases of hepatitis A were reported. Rita Sethi, director of community health and wellness at the health unit, says the rush reminded her of the first flu
RN Jessica Hales (right) wants to see 24-hour drop-in women’s shelters.
shot campaigns in the early 2000s. Timely vaccination can prevent an exposed person from developing hepatitis A, an infection that affects liver function. While the risk of contracting the disease from a food handler is low, it has happened in the province before, and it’s better to be safe than sorry, Sethi advises. “Getting hepatitis A would not be a fun thing,” she says. “You can be
sick upwards of four weeks. There are some complications associated with it, although it’s not one that people would typically die from.” (Guelph Mercury, Jan. 24)
Red Scarf Project brings awareness of HIV/AIDS Downtown Woodstock was briefly filled with red scarves in December as nurses from
e news Oxford County Public Health Unit used them to raise awareness of HIV/AIDS. Each of the 75 scarves was knit by volunteers, and was hung on either a tree or lamp to look like the red HIV/AIDS ribbon. An information card was attached, explaining the significance of the ribbon and ongoing HIV/ AIDS issues. “People are welcome to take those scarves if they need, and hopefully read the information tags, and spread (what) they learn,” says public health nurse Gayle Milne. This is the second year in a row the county has participated in the Red Scarf Project, an international initiative coinciding with World AIDS Day on Dec. 1. The scarves were hung throughout the downtown area, and within hours, just a few remained. Milne says initiatives like this allow nurses to reach segments of the community they don’t
by Daniel punch
encounter on a regular basis. “It’s a subject that doesn’t get talked about very often, so any opportunity...to get that message out there and get people talking is a good opportunity,” she adds. (Woodstock SentinelReview, Dec. 2)
Dynamic nursing student marches to the beat of her own drum Nursing student Yessica Belsham has made a name for herself at RNAO. She is heavily involved with three of the association’s interest groups and serves on the executive of the Kingston chapter. And she does this while studying for her nursing degree at Laurentian University/St. Lawrence College. But it was Belsham’s artistic endeavours that recently caught the attention of the Kingston media. She was named resident artist at a local art studio, where she
will showcase drums she makes out of recyclable material. Belsham traces her love of drums back to one night in Kingston, when she followed a distant drum beat and found a local group performing samba music. “Those drums touched a part of me and changed my life. (They are) like the heartbeat of the core,” she explains. A week later, she joined that samba group, and she now leads a local drum circle. Belsham also paints and makes jewelry, and says her artistic interests helped to lead her toward nursing. During her previous studies at the Ontario College for Art and Design, she attended a session for illustrators focusing on the human body. This sparked her interest in biology. Belsham would like to become a palliative-care nurse. “I’m passionate about our elders and their experiences,” she says. (Kingston EMC, Jan. 15)
Photo: Adam nyp/Woodstock Sentinel-Review
Working with seniors to prevent falls
For the second consecutive year – and to mark World AIDS Day – public health nurses, including RNAO member Gayle Milne (right), decorate trees and posts in Woodstock with red scarves to raise awareness of HIV/AIDS.
Falls are the leading cause of injury among people over 65, but their impact can be minimized by taking appropriate precautions, says RN Sarah Gibbens. The Public Health Agency of Canada estimates one in three Canadian seniors fall every year, and the Ontario Medical Association says falls account for nearly 60 per cent
Nursing student Yessica Belsham is named resident artist at a Kingston art studio, where she will showcase the drums she makes out of recycled materials.
of emergency department visits and nearly 80 per cent of hospitalizations among the elderly. “Falls can be incredibly disastrous for older adults,” says Gibbens, a geriatric emergency management nurse at Northumberland Hills Hospital. She advises older patients to make changes that reduce the risk of falls, including incorporating non-slip surfaces in their homes, and removing hazards such as loose rugs. She also encourages them to watch for changes in their balance caused by their medications. Above all, Gibbens tells her patients to stay mobile, and to not be held back by fear of falling. “It’s the use-it-or-lose-it principle. If someone is afraid of falling, they gradually become less likely to get up and move,” she says. “In time, the leg muscles weaken quickly, making falling more likely.” (Northumberland Today, Dec. 12) Registered nurse journal
9
nursing in the news Nurse applauds Ontario government for “vapes” legislation While the jury is still out on the long-term effects of using e-cigarettes, legislation that applies the same restrictions on the new product as those applied to other tobacco products is a positive and proactive step, says Algoma Public Health nurse Janet Allen. “We are (still) waiting on the science,” she says. “There is concern that history could repeat itself – look what we have gone through with (tobacco) cigarettes.” E-cigarettes – known as “vapes” to many users – are battery-powered vaporizers that mimic cigarette smoking.
They contain nicotine but no tobacco, and are marketed as a safe alternative to regular cigarettes, and a means to quit smoking. In November 2014, the provincial government introduced the Electronic Cigarettes Act. If passed, it would ban sales of e-cigarettes to youth and ban their use in restaurants and public buildings.
“Right now, it’s a proactive approach until we can be certain of (their) safety,” Allen says, adding there are simply too many unanswered questions. With flavours like Green Apple, Sweet Watermelon and Vanilla Craze, there is also growing concern that e-cigarette manufacturers are trying to appeal to young people. “E-cigarettes use marketing strategies similar to cigarette ads, available in whimsical flavours that youth are very susceptible to,” Allen warns. (Sault this Week, Dec. 4)
RNAO visits China RNAO CEO Doris Grinspun (centre) and IABPG Director Irmajean Bajnok (not pictured) visited China in January to present a week-long leadership program for nurse executives in Beijing. Invited by the Chinese Nursing Association, Grinspun and Bajnok offered training that was based on RNAO’s best practice guidelines, and that focused specifically on visionary leadership, strategic planning, empowerment, evidence-based management, clinical governance and budgeting.
10
January/February 2015
Assisted dying debate extends to Canada’s newborns Now that the Supreme Court of Canada has ruled that Canadians have the right to medically assisted death, some are raising the difficult question of whether the right to die should extend to the country’s youngest citizens. A recent story on CBC Radio’s The Current featured Queen’s University bioethicist Udo Schuklenk, who wrote a paper defending the morality of euthanasia for some newborns with terminal illness. The story also featured Lynn Grandmaison Dumond, an advanced practice nurse with the palliative care team at Ottawa’s Children’s Hospital of Eastern Ontario. Grandmaison Dumond says she “too often” must provide palliative care to newborns and their families. She works with families whose children face a variety of challenges, including not being able to breathe or feed on their own. If a terminally ill infant faces a prolonged life of suffering, families often must make excruciating decisions about their child’s future. “We (don’t) hasten death, but we may remove treatments we’ve initiated...where we feel this is not in the benefit of the child,” she says, referring to ventilation, feeding tubes, or other life-extending measures. While these are hard conversations to have with families, Grandmaison Dumond says proper palliative care and guidance are important in these unfortunate scenarios. “I believe that palliation is part of the continuum of health care we offer. Families need to be aware of their options.” (Dec. 9) RN
nursing notes continued
RN from Iran wins recognition for helping IENs Ahmad Baki arrived in Canada in 2006
Award, named after a former RNAO president
and remembers being on a Toronto subway,
and administered by CARE Centre for IENs, a
searching for a hospital where he might find
bridge training program. Baki, who has worked
work. He asked a woman on the train for direc-
as an RN in Iran (his native country), Dubai,
tions to the closest hospital, and she promptly
Kuwait and Europe, is no stranger to awards,
offered to call 9-1-1. Baki reassured her he
but says this one is particularly important
didn’t need medical help, but was looking for a
because it represents his passion to give back
job. As it turned out, she was a retired nurse,
to the nursing community. “Like many IENs,
and instead of directions, provided him with
my first job in Canada was as a PSW before I
some very useful advice and guidance about
gained my RN registration and secured a posi-
the process of becoming an RN in Ontario.
tion at Princess Margaret Hospital seven years
Since that experience, Baki has dedicated him-
ago,” he says. “Working…in a world-class
self to helping other internationally educated
hospital is a dream-come-true.” Humble and
nurses (IEN) reach their goals and potential.
soft-spoken, Baki says he owes his success
He was recognized in 2014 for that work when
in a new country to his wife, Maryam Oghbaie.
he received the Joan Lesmond IEN of the Year
“Without her help, I’m nothing.”
Ending homelessness with help from expert panelists
homelessness, and inclusion for
and Minister Responsible for the
supports for patients, mandatory
people with mental illness and
Poverty Reduction Strategy. The
reporting requirements, and oppor-
addiction. Creek is director of
province will develop a plan of
tunities for public participation in
Two people with impressive track
strategic initiatives at Working
action based on the panel’s rec-
disciplinary proceedings. They will
records for raising the issue of
for Change, and a former board
ommendations, and will report on
provide advice and recommenda-
homelessness will join 11 other
member at Canada Without Pov-
progress annually.
tions on how to strengthen the
experts to provide
erty. Drawing on his
recommendations to
personal experience
the provincial govern-
with homelessness and
Task force on sexual abuse of patients
ment as it works to
poverty, he has been
The Regulated Health Professions
professions, as will the recommen-
end homelessness
a long-time advocate,
Act, 1991 will be reviewed in
dations made by the task force. RN
and poverty in Ontario.
speaking on behalf of
2015, in an effort to better pre-
RNAO member Cheryl
marginalized Ontarians
vent and deal with sexual abuse of
Forchuk, and Friend of
through presentations
patients by regulated health pro-
to legislative com-
fessionals. RNAO member Sheila
have been appointed
mittees and keynote
Macdonald, provincial co-ordinator
to an expert advisory
addresses. Creek took
of the Ontario Network of Sexual
panel thanks to their
home RNAO’s Hon-
Assault/Domestic Violence Care
expertise and ongoing
oured Friend of Nursing
and Treatment Centres (SATC), is a
advocacy. Forchuk,
Award last year.
member of the task force that will
RNAO Michael Creek,
Cheryl Forchuk
Part of the panel’s
who won RNAO’s Leadership in Nursing Research award last
Michael Creek
legislation and reinforce the province’s zero tolerance policy. The Act applies to all regulated health
In memoriam RNAO extends its deepest condolences to family and friends of
take on this work. She has been
role is to help define
provincial co-ordinator of SATC for
homelessness, as
over two decades, and played a
year, and became an Honorary Life
there is no consistent definition or
leading role in the development of
Member in 2012, is an interna-
method for counting the number
the Sexual Assault Nurse Examiner
tionally respected researcher on
of homeless in the province.
(SANE) role in Ontario. Macdonald
homelessness and mental health.
The panel will be co-chaired by
and her task force co-chairs will
At Western University, where she
MPP Ted McMeekin, Minister of
look at the definition of sexual
is a professor in nursing and
Municipal Affairs and Housing,
abuse contained in the legisla-
psychiatry, she explores issues
and Deb Matthews, Deputy Pre-
tion, disciplinary orders that may
related to poverty, housing,
mier, President of Treasury Board
be imposed by regulatory bodies,
Norma Marossi September 4, 1930 to December 15, 2014 President of RNAO, 1975-77 Honorary Life Member, 1993
Registered nurse journal
11
road to
12
January/February 2015
Doctors living with addiction have the Physician Health Program. Dentists have a resource network. Nurses do not have a dedicated program to help address their unique needs when overcoming substance-use issues. But that may soon change. by Melissa Di Costanzo
recovery
K
athy* spent Christmas 2009 thousands of kilometres away from her two teenage children. It was a devastating turn of events for the then-49-year-old, who had celebrated more than a dozen holidays with her husband and daughters (then 16- and 17-years-old). It wasn’t her first Christmas without them. That’s because three years earlier, the couple divorced, and the girls blamed their mother for splitting up the family. “They were so angry at me, they didn’t want to speak to me,” Kathy recalls. Hoping to start a new life, she moved from London, Ont. to British Columbia in 2009. There, “everything just fell apart on me.” In an effort to extend an olive branch, Kathy invited her kids to her new home. They refused. And for Kathy, it was the last straw. Crushed by her children’s estrangement, and freshly isolated from her support network, Kathy, a registered nurse of more than 30 years, turned to morphine after wrestling with a substance-use disorder for almost two decades. “When you have the disease of addiction, there’s no off switch,” Kathy says, reflecting on the time. “You don’t take the drug. The drug takes you.” Kathy’s story is far from unique. Addiction is a very real hazard in high-stress nursing environments, where drugs can be obtained through fraudulent paperwork or by diverting patient medications. And substance use, in many cases, goes handin-hand with mental-health issues. According to Toronto’s Centre for Addiction and Mental Health (CAMH), in any given year, one in five Canadians experiences a mental health or addiction problem. Nurses – as well as other health professionals – are no exception. Addiction is a disease that does not discriminate.
* Pseudonyms have been used to protect privacy
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When it comes to the prevalence of substance use among nurses, Canadian figures are elusive. The College of Nurses of Ontario’s (CNO) system for tracking complaints and reports of substance misuse does not get that specific. Statistics from the U.S. suggest frequency parallels that of the general population: approximately 300,000 U.S. RNs, or 10 per cent of the workforce. The College of Registered Nurses of British Columbia cites the same ratio. Kathy’s story can be traced back to 1970, when she was 10 years old. She was diagnosed with excruciating abdominal pain, caused by sporadic – and often unpredictable – spasms in her pancreas’ sphincter. After one trip to the ER, she was given Demerol – her first taste of relief. “I believe I had a strong genetic predisposition to addic-
nursing license back – with conditions set out by CNO that will be monitored and eventually lifted unless she relapses. She must submit two witnessed urine tests each week, see a physician every three months, and attend a support group for health-care professionals. Until these sanctions are lifted, she can’t administer or handle narcotics. Not surprisingly, these limitations have made it hard for Kathy to find a nursing job. She’s been looking for three years, while working a handful of minimum wage positions to make ends meet. “I had a lot of hope when my license was first reinstated,” she says. “(But) I’ve been met with such negativity and judgment (that I have) little hope now of ever getting a nursing job.”
She would double patients’ dosages, administering half to the patient, and taking the rest home. She also signed out meds for non-existent patients. tion,” she says, acknowledging that although she was young, she recognized the connection between the drug and that sense of relief. A few years later, at 15, Kathy began binge drinking socially. She says this is when that predisposition really began to take shape. “I always overdid (it) with alcohol; no question,” she says, adding that as she left puberty and became an adult, one of her personal mantras became “work hard, play hard.” She drank and used sleeping pills to help her feel “better, normal, (like) you can cope in the world.” “I’ve always struggled with alcohol abuse,” she adds. “I was born an alcoholic and an addict.” The demands of nursing in ERs and ICUs – where Kathy spent most of her nursing career – only added to the turmoil. Due to understaffing, she would often be forced to take on two patients instead of the customary one. Kathy admits she often felt stretched thin. “I enjoy (work) very much, but it’s a certain kind of stress,” she says. She continued using drugs and alcohol into her 30s and 40s, admitting her substance use worsened when she separated from her husband. On her own in B.C., she knew what would take that pain away. “I felt extremely helpless. There was nothing left to live for,” she says. At the height of her illness, Kathy was working at a hospital in Victoria, B.C. She would double patients’ dosages, administering half to the patient, and taking the rest home. She also signed out meds for non-existent patients. After six months of using morphine to numb the emotional pain, she was called in to a meeting with her manager and a union representative. “I knew,” says Kathy. “At that point, I was actually very glad. I had tried to control it myself and I was in such a living hell, I just wanted it stopped.” After acknowledging she needed help, Kathy moved back to Ontario to seek treatment, and began her long road to recovery. Today, Kathy is almost five years sober. She has her Ontario 14
January/February 2015
W
hen she was in B.C., Kathy admits to reacting with aggravation when she helped care for a patient in the ICU who had overdosed for the 15th time in a month. “It’s easy to get into black-and-white thinking (that) they’re just bad people,” she says. Kathy acknowledges that kind of reaction is not an uncommon one among health-care providers. Now, she sees things differently, and can reflect on moments like this with personal experience. “The best way to understand addiction is not as a moral weakness, but as a disease,” she says. “These people need support and help.” Harry Vedelago is a physician who once experienced a substance-use disorder himself. He used to lead therapy sessions in Hamilton with Caduceus Group, a nation-wide support network that assists health-care professionals with substance-use disorders. Now chief of addiction medicine at Guelph’s Homewood Health Centre, he echoes Kathy’s comments. “Addiction is a chronic…disease. It’s not a lifestyle choice, self-will or self-medicating. It’s a disease state,” he says. In fact, treatment and outcomes of substance use are similar to those of other chronic illnesses, such as diabetes and cardiovascular disease. If treated, the outcome can be good. If left untreated, the prognosis is much grimmer: long-term complications or even death. Vedelago has found that when health-care professionals are able to access recovery programs with proper monitoring procedures, the results are impressive. “You’re hitting sustained recovery rates of 80 to 90 per cent,” he says. “That’s amazing.” Caduceus Group offers a no-fee recovery program, which includes treatment, after-care and 12-step meetings. Healthcare providers are usually encouraged to attend through their licensing body, professional association, employers, or healthcare providers. Attendees are also referred by their physicians. Vedelago says the number of nurses who attend always outweighs
the number of other professions, simply because there are more than 104,000 RNs eligible to work in Ontario alone, and roughly 42,000 RPNs. Given these numbers, support that is designed exclusively for nurses, such as group counselling, is essential. At a December CNO council meeting, roughly $500,000 was set aside to start working on a nurse health program. RNAO, the Ontario Nurses Association (ONA), the Registered Practical Nurses Association of Ontario (RPNAO) and CNO are involved in the project. The four organizations have been working together to draft a project plan for the program, and work is underway to proactively address “high-risk incapacity matters” in the “least intrusive manner, while protecting the public,” according to CNO’s December council meeting notes. The goal is to employ a recovery management model, putting clients in the driver’s seat of their long-term recovery. The Ontario Medical Association started the Physician Health Program in 1995 to help its members with, among other things, substance-use issues. Physicians are offered assessment services, advice and treatment. The Royal College of Dental Surgeons of Ontario has partnered with three drug and alcohol treatment and recovery centres to support Ontario dentists. And, in 2012, the Canadian Dental Regulatory Authorities Federation and the Canadian Dental Association sponsored and organized a two-day conference called On the Road to Wellness: Dealing with Addiction Disease in Dentistry. Nurses still have no equivalent, but news of the funding through CNO is encouraging. Nurse practitioner Rosie Yoon is an advanced practice NP who works at Toronto’s Jean Tweed Centre providing care to women recovering from substance use and living with mental-health concerns. She says stronger supports need to be in place for nurses experiencing a substance-use disorder. “It saddens me because we’re trained…to be empathetic, compassionate, recovery-oriented, and all of those things are very poorly reflected in the system of services and resources we have for our colleagues,” says the RN of 10 years, who has worked at CAMH and St. Michael’s Hospital’s acute inpatient psychiatry unit. Yoon cares for nurses overcoming substance-use disorders in her current role, and says supportive workplaces – starting with occupational health and safety and human resources departments – can make all the difference. Policies that clearly outline process when it comes to responding to a nurse’s substance use are imperative, she says. Awareness campaigns normalizing substance use as a health issue and teaching nurses about vicarious trauma/compassion fatigue (the negative impact of caring for others), stress and mental-health issues will go a long way towards creating a culture of compassion, Yoon adds. “Substance use in general in our society carries a heavy stigma and misunderstanding.” Nurse Practitioner Rosie Yoon CNO also has a critical role to play, she says. “The risk of (nurses) losing (their) license is huge,” Yoon explains. “That’s the biggest fear…and the biggest barrier to people asking for help.” “The college needs to be transparent (and say) ‘we’re here to support you, and to support clients,’” she adds. Karen McGovern, CNO’s director of professional conduct, acknowledges the legal – and often lengthy – process to determine a nurse’s capacity to practise after disclosure of a substance-use disorder can be
You’ve disclosed a substanceuse disorder to your supervisor.
Now what? Managers and supervisors
The individual who is being
are legally required to report a
investigated has another
substance-use disorder to the
opportunity to respond
College of Nurses of Ontario
and could, at this point, be
(CNO) within 30 days. They
referred to the Fitness to
can also report if they have
Practise Committee. This
information that indicates
referral is posted to Find
a nurse’s judgment is com-
a Nurse, a website that
promised, such as tardiness
provides the public with
or discrepancies in narcotic
information about nurses
administration.
in Ontario and any practice
CNO assesses the complaint/ report for potential risk to the public. Information about the nurse’s health is reviewed by CNO’s executive director, who must start an inquiry if the information leads to a reasonable belief that the nurse has
restrictions. A referral to the fitness to practise committee may lead the inquiries committee to suspend or restrict a nurse’s licence (if there are urgent safety concerns) until the adjudication has wrapped up.
a condition and it is having an
Between 75 and 90 per
impact on safe practice.
cent of matters referred to
The nurse is notified, and has the opportunity to provide health information (there is, however, no obligation). That information is then forwarded to the Inquiries, Complaints
the committee are resolved without adjudication. CNO negotiates with lawyers, and sometimes with the nurse directly, to reach an agreement that is reviewed by a panel.
and Reports Committee,
Once the nurse has com-
a five-member panel that
pleted the terms of the
decides if the RN should be
agreement, CNO sends a
considered “incapacitated”
letter to the nurse, stating
and in need of licence
the restrictions have been
limitations.
lifted. If a nurse experiences
The committee can request an independent medical
a full relapse, the entire process starts again.
assessment, conducted by
Since 2010, there have
a physician not involved in
been anywhere between 69
the nurse’s treatment. The
and 101 referrals per year
doctor provides a report that
to the fitness to practise
is disclosed to all parties.
committee, most of which
A nurse can be suspended
concern substance-use
from practice if the inquiries
disorders and/or other
committee asks for a medical
mental-health disorders.
assessment, and that requirement is not met.
Registered nurse journal
15
difficult. “The college’s (goal) is to make sure we can identify…risks and do what needs to be done to protect the public,” which also means getting nurses into treatment and returning to practice. “Part of the public interest is access to great nurses,” she says, adding: “Everyone involved in the process here at the college is extremely respectful of the circumstances of these nurses. We’re delighted when someone returns to practise successfully, and completes their conditions.” McGovern says the college spends “as much time as we need” to explain the legal process to nurses. If the investigation leads to a “fitness to practise” hearing (75-90 per cent of cases are resolved without a hearing), privacy is respected by closing that hearing to the public. And, McGovern adds, the public information that is posted online at Find a Nurse is a high-level summary, and doesn’t contain personal or private health details. Substance-use disorder is not identified as such, but rather grouped under a “health condition.” For its part, RNAO offers its Legal Assistance Program (LAP) to support nurses through CNO proceedings, including incapacity investigations. ONA helps unionized nurses in meetings with their employers, provides members with representation at CNO hearings through its legal expenses assistance fund, and files grievances on behalf of nurses, if necessary.
Nurse publishes her story to help others An RN of three decades, Idaho-based Karolyn Crowley began swiping samples of Vicodin for almost two years, beginning in 1995, to relieve menstrual cramps. She convinced herself that over-the-counter medications just wouldn’t cut it. At the time, she worked for an ear, nose and throat surgeon who specialized in head and neck cancers. Members of her family struggled with alcoholism, “…but I still never thought (addiction) would happen to me.” After several attempts to quit the drug, a colleague confronted Crowley, an experience she now considers a blessing. She started on her road to recovery 17 years ago, and recently decided to share her experience and advice in a book called Re/entry: A Guide for Nurses Dealing with Substance Use Disorder. The recently released guide for nurses trying to overcome addiction and resume their practice is also an educational roadmap for supervisors, colleagues and administrators. The content is presented in a conversational way to guide readers through the various stages of addiction while providing tips for those hoping to reenter the job market. Crowley and her co-author, Carrie Morgan, a recovery coach, couldn’t find any books designed to help nurses transition back into their jobs when they began writing. Crowley says she wishes a book like this existed when she wrestled with her own addiction. “I walked around with this secret for a long time,” she says, adding: “Nurses don’t believe it’s a disease, and if we don’t believe it’s a disease, how can we take care of our patients and ourselves?”
A
lison* considers herself lucky to have all the ingredients necessary for a successful recovery – including help from friends and family, and a supportive work environment. She used to work as a psych nurse in the emergency department at a northern Ontario hospital. After swapping scrubs for street clothes, she would often go to a local bar with girlfriends to have a few drinks. Some nights, she’d head to a local restaurant with a friend, order the Cajun shrimp and split a bottle of wine. It seemed routine, and Alison thought nothing of it. Then she began drinking to fall asleep. She worked mostly evenings in the ER and, after returning home most nights around midnight, found it difficult to wind down, likening the end of her shifts to a rock star finishing a set: adrenaline coursing through her body. “I just couldn’t shut myself down.” The high-drama and intensity of the ER, coupled with the severe illness of some of her patients, sent her mind racing, and Alison needed to apply brakes. She started by sipping one or two glasses of wine before she tucked in. But as time passed, she needed more and more just to get a decent night’s sleep. Soon she began binge drinking three or four nights a week, blacking out at least once. After three years, Alison realized she needed help. “I did everything I could to keep it hidden… until I just couldn’t keep it hidden anymore.” She told her manager, who was then legally responsible to disclose to the college. CNO drew up a contract outlining everything from Alison’s hours of work to her treatment plan. The five-year agreement (she is now at the four-year mark) set out that, in year one, Alison could not work more than 37.5 hours per week, or nights and evenings. She had to submit urine drug screens three times a month in the first year (that dropped to bimonthly in year two, and once a month for the final three years). She must meet with her psychiatrist once a month for the entire five years. Other nurses have similar contracts. Some find them daunting, but Alison, now a manager in one of Ontario’s largest regions, says it has “absolutely worked” for her. She shares her story with co-workers. Yet she wants to remain anonymous for this story because she wants to protect her organization. She’s afraid clients who discover her past (she’s been clean three years) will think she’s unfit to do her job. “Unfortunately, until we get rid of the stigma, this kind of stuff is going to keep happening,” she says, referring to people’s fear of speaking out. Kathy agrees that stigma gets in the way of disclosure. She says she would have reached out for help earlier, had she not feared losing the job she loves or judgment from colleagues. “In the health-care field, we’re supposed to be the caretakers; it’s very difficult for us to ask for help,” she says. “We’re supposed to be the strong ones.” The stigma Kathy experiences from colleagues is hurtful, she says. “It’s so sad that we cannot extend the same compassions to our own members that we do to (clients),” she adds. “The subject of addiction at the professional level is so often, if not always, swept under the rug. By ignoring the problem, you just drive it underground.” Kathy is grateful she was given a second chance when she needed it. And she’s appreciative her relationship with her daughters has improved (though they don’t see each other often, they talk regularly over the phone). “Because of what I have gone through,” she says, “I know I’m a kinder, wiser, healthier nurse and human being.” RN melissa di costanzo is staff writer at rnao.
16
January/February 2015
policy at work Safeguarding Ontario’s blood supply In a rare show of all-party support, Ontario MPPs unanimously agreed to pass a law in December that bans for-profit companies from offering money for blood or plasma donations. Regulations to prevent tainted blood products from being sold were contained in Bill 21, the Safeguarding Health Care Integrity Act. The need for the legislation was prompted by news that a company called Canadian Plasma Resources (CPR) planned to open two sites in Ontario, and would offer compensation to plasma donors. Plasma is the part of the blood that transports water and nutrients to cells in the body. RNAO first alerted Health Canada to this troubling collection of blood for profit in 2013. When it learned of CPR’s intentions, it issued action alerts and letters to the premier and health minister outlining the dangers of such a move based on what happened in the 1980s. Back then, thousands of Canadians became infected with HIV and hepatitis C from tainted blood and plasma that was imported from the U.S., where donors (some of them incarcerated) were commonly paid but not always properly screened. As a result of the scandal, Justice Horace Krever was appointed to look into the matter. In 1997, the Krever Commission recommended blood and blood products used in Canada come from unpaid donors. In December, Health Minister Eric Hoskins said the province’s move to make payments for blood and plasma donations illegal was in keeping with Justice Krever’s
Tim Lenartowych, Associate Director of Nursing and Health Policy (left), and Senior Economist Kim Jarvi, present RNAO’s pre-budget recommendations at Queen’s Park on Jan. 29.
recommendation to maintain a voluntary blood supply system and prevent vulnerable people with infectious diseases from selling their blood for cash. The association had a chance to weigh in on the legislation, and applauded the government for taking action to resist market forces that would compromise the blood supply. The decision also upholds the health system’s not-for-profit status.
Proposal about psychotherapy leaves some nurses with unanswered questions Registered nurses trained in psychotherapy appear to have hit a roadblock as a result of a proposal set out by the College of Nurses of Ontario (CNO). The issue dates back to 2006, when the Health Professions Regulatory Advisory Council (HPRAC) recommended the ministry of health designate psychotherapy a controlled act to improve public safety (psychotherapy is the treatment of mental and emotional
disorders). The colleges that regulate occupational therapists and social workers, and a transitional college for registered psychotherapists, have all developed professional practice standards related to psychotherapy that do not require an order to provide the service. However, CNO will require that RNs obtain an order (from a nurse practitioner or a physician) even if an RN has demonstrated expertise and has worked in this specialty area. RNAO, the Mental Health Nurses Interest Group, and experienced RN psychotherapists have all written letters to CNO asking it to reconsider its decision, and to develop professional practice standards for psychotherapy similar to those of other colleges. To find out more, visit www.RNAO.ca/psychotherapy
RNAO gives pre-budget prescription to MPPs RNAO’s policy department made a presentation before the Standing Committee on Finance and Economic Affairs
at Queen’s Park on Jan. 29. Associate Director Tim Lenartowych and Senior Economist Kim Jarvi spoke about some of the challenges registered nurses and nurse practitioners face in their practice, including RN replacement and the salary discrepancy for RNs and NPs who work in the community versus those who work in hospitals. They also touched on the need to speed up RN prescribing, anchor the system in interprofessional primary care, legislate a ban on medical tourism, increase the minimum wage to $14/hour, and reduce people’s exposure to toxics. Lenartowych says he hopes the list of recommendations proposed by RNAO will be included in the Ontario government’s spring budget, adding that all of the above can be achieved if the government adopts progressive taxation proposals suggested by the association. RN Read the full pre-budget submission at www.RNAO.ca/Budget2015
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A lifetime in long-term care Ontario’s long-term care homes are seeing an increase in younger residents with disabilities and mental-health issues, and many question if it’s an appropriate environment. by Daniel Punch
L
ike many 24-year-olds, Michael Wedemeyer loves music, and gets excited discussing heavy metal and rap. “I like Eminem, he’s my favourite of all time,” he asserts, giggling enthusiastically. “I like rap. Not the old-type stuff,” he quickly points out. Michael has a hard time avoiding the “old-type stuff” these days, because unlike most 24-year-olds, he lives alongside 170 senior citizens in a long-term care home. In 2011, an aneurism and three strokes changed Michael’s life forever. He suffered a serious brain injury, developed epilepsy, and lost much of his mobility, particularly on the left side of his body. His short-term memory was severely affected, and he struggles to retain new information. After the injury, Michael bounced from hospital to rehabilitation centre and back to hospital. His family couldn’t provide the 24-hour care he needed, so he couldn’t live at home. Unable to stay in hospital forever, his family searched for an appropriate alternative and found only one option: long-term care. Michael moved into Norfolk County’s Norview Lodge in 2012. While he remains positive and cheerful, life in long-term care hasn’t always been easy. Michael likes loud music and motocross, 18
January/February 2015
and his boisterous laugh fills a room. This doesn’t always sit well with older residents who prefer Bing Crosby, bingo and quiet time. Michael is young enough to be someone’s grandson, and the older population sometimes treats him as such, scolding him when he gets loud. “Sometimes they’re mean to me and hurt my feelings,” he has said in the past. It’s not just about fitting in. Michael is in the middle of a long journey toward recovery. Since the aneurism and ensuing complications, he has worked hard to regain his speech, and is gradually building his strength and range of motion. If he’s ever going to get back to a “normal life,” Michael requires more aggressive rehab than staff at Norview Lodge can provide. “We do very well with what we have (but) I can’t say there isn’t more for him,” says Norview administrator Bill Nolan. “This young man, in our eyes, deserves to have some chance at a different sort of life than what he has right now.” Michael isn’t alone. Across Ontario, people under the age of 65 are being placed in long-term care homes because they have nowhere else to go. Community housing can’t keep up with the demand in Ontario, where an estimated 62,000 adults live with developmental disabilities, and countless others suffer from
Photography: HILARY GAULD-CAMILLERI
Long-term care homes don’t receive additional mental illness and other chronic conditions that require Michael Wedemeyer suffered an aneurism funding to accommodate for the younger population, constant care. As of 2013, there were more than 3,400 and three strokes so they struggle to develop unique programming to people (18 and older) with developmental disabilities in in 2011, leaving keep them active and engaged. To make matters worse, Ontario long-term care homes. him in need of 24-hour care. He once placed in long-term care, funding models change, Ideally, these people would live in group homes or supnow lives in a longand many young residents lose the financial support ported living settings. Since the 1960s, Ontario has been term care home. for outings, job placements and other programs they closing institutions for people with developmental disaccessed before via social-services programs, Pow says. abilities and mental illnesses in favour of group homes run by local Many subsist solely on the Ontario Disability Support Program agencies. In these homes, residents are supported by trained staff (ODSP), which provides a comfort account of just $138/month. who focus on fostering independence and community inclusion. This doesn’t leave much cash for a 30-year-old to live a fulfilling The trouble is, there aren’t enough group home beds to go around. life, she points out. Bored and isolated, many of these residents RN Karen Pow is administrator at Woodlands of Sunset, a get frustrated with their surroundings. 120-bed long-term care home in the Niagara region. She has Pow remembers a 40-year-old woman from her previous workworked in the sector for nearly two decades, and says she’s seen place who was struggling with an acquired brain injury. She hated a definite increase in the number of younger residents. In one living in long-term care, and wasn’t shy about letting others know. former workplace, as much as 20 per cent of the resident populaHer aggression would often come out at meal times. “I hate f****** tion was under 65. old people!” she’d stand up and yell, and staff had to be on constant Long-term care homes are designed for older adults who are guard against physical altercations with older, more fragile residents. reaching the end of their lives, not young adults with decades to live, Long-term care has become a “catch-all” for people who don’t Pow says. “I’m not saying it’s a bad environment, I just don’t think fit anywhere else, regardless of age, says Christina*, an RN and it’s conducive to fostering independence,” she admits candidly. Registered nurse journal
19
director of care at a Greater Toronto Area (GTA) home. Christina is 70-years-old, and says the majority of new applications she receives come from people younger than she is. Without appropriate funding and staff, Christina says it often feels like younger residents are just being “warehoused” for as long as their lives may last. “They sit, and they sit, and they sit, and nothing happens. They don’t get any better (and) they don’t get any worse,” she laments. “Human beings, if we have nothing to strive for, we’ll just wither away.” Christina would like to see government reexamine a system that lets so many people fall through the cracks. “We’re not doing this right as a society. We’re not filling this huge gap. What can we do to rectify it?” Properly funded units designed specifically for the younger population in long-term care would be helpful, Christina says, but ultimately housing via social services must be available to more people. “Entering a long-term care home requires careful consideration by the individual and their family,” says Ministry of Community and Social Services (MCSS) spokesperson Kristen Tedesco. Last
of developmental disabilities. “He was bored to death,” says the home’s director of care and RN, Jenny Power. David just didn’t have the resources to participate in community programs, and he dismissed the home’s regular programming as “old people” activities. Staff noticed he spoke proudly about helping his dad at work when he was younger, so Dufferin Oaks gave him a job in the laundry department. He now works routine hours for two or three days a week, has regular duties, and reports to the manager. “(David) loves it, he always talks about it and he sets his day around it,” Power says. “That’s going very, very well.” Grandview Lodge in Haldimand County unofficially transformed one of its units into a wing for people under 65, who comprise about 10 per cent of its population. They turned the “quiet room” into a games room, and tried to adapt activities for a younger demographic. Under the Long-Term Care Homes Act, individual homes can designate specialized units and, through their Local Health Integration Network (LHIN), limit admissions to the corresponding population. Grandview staff met with their
Without appropriate funding and staff, it often feels like younger residents are just being “warehoused” for as long as their lives may last.
spring, MCSS recognized the need to expand developmental services, committing $810 million over three years. The funding should provide residential support for about 1,400 people with urgent needs. It will also enhance the ministry’s Passport program, which provides funding for people with developmental disabilities to participate in the community. Long-term care residents are eligible to apply. The government’s investment is a start, but it still leaves thousands of young Ontarians in long-term care homes. Funding for developmental services won’t address the limited resources for people with mental illness and other disabilities. And for those already living in long-term care, it is difficult to obtain funding to move elsewhere, since they’re already receiving 24-hour care. Because of this reality, many long-term care homes have had to come up with creative ways to improve quality of life for their younger residents. It didn’t take long for David* to tire of his new life at Dufferin Oaks long-term care home in Shelburne. David, 51, was born with Fragile X syndrome, a genetic condition that causes a range 20
January/February 2015
Chrissy Wedemeyer (right) is Michael’s aunt and guardian. She works at Norview Lodge, where Michael lives.
local LHIN, but found no additional funding available to support the initiative, says administrator Joanne Jackson. “We have to do the best we can with the funding we have and the admissions we have,” she says. Without exception, every long-term care professional featured in this story agrees their homes are not appropriate for younger residents. They all concur these individuals would be better off in a group home that fosters their independence. This includes Chrissy Wedemeyer, Michael’s aunt and guardian, who works in housekeeping at Norview Lodge, where Michael lives. When she imagines Michael’s ideal future, she sees him living a long and “normal life” among his peers. He’s receiving the rehab therapy he needs, and is working or volunteering in the community. Above all, he can be himself. “He could have a friend spend a night at his apartment,” she imagines, “and he can crank the tunes all night.” RN daniel punch is editorial assistant at rnao.
* Pseudonyms have been used to protect privacy
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Teens helping teens 22
January/February 2015
Unique RNAO-led program arms students with tools to use as they help other youth better understand the importance of good mental health. by Melissa Di Costanzo
A
shake-it-off kind of thing,” he said. “It’s cool to teach people, to help sk a roomful of 60 teenagers to list the them learn more about what it actually is.” things that affect their mental health and the On day two, the students reviewed an online mental-health quiz responses are poignant and more or less what developed by mindyourmind. They were asked to devise additional you’d expect. A lack of confidence. Stress. Peer questions to those already on the quiz, such as: self-harm is a coping pressure. Being judged. Feeling unattractive. strategy, true or false? What are the signs of stress? True or false: you Helping teens to address these issues, and can call a distress line to talk about a friend who you think is in crisis. building resilience, is at the heart of a new partThe students who participated in the November training will add nership between RNAO and six public-health units across Ontario. their own quiz questions, and will promote the quiz to their local Representatives from these organizations want youth to feel peers in the hope of raising more awareness around mental health. empowered to help their peers through mental-health promotion, Upon completion of the two-day event, the students qualified as stigma reduction and substance-misuse prevention, which is why, “youth leads,” and were ready to start planning activities in their a year ago, they formed the Youth Mental Health and Addictions own schools, with the help of adult allies. The youth leads will train Champions (YMHAC) project. peers – called youth champions – in their school communities, The barely 12-month-old initiative is funded through the Ontario and all will work together to create youth-engagement strategies. Ministry of Health’s Healthy Communities Fund, and includes other “They were pumped,” says Kristi McCracken, a public health stakeholders such as mindyourmind, a youth mental-health pronurse who works at John Diefenbaker Secondary School (JDSS) in gram based in London, the Ontario Centre of Excellence for Child Hanover, about an hour south of Owen Sound. She attended the and Youth Mental Health, and School Mental Health-ASSIST. training as YMHAC project co-ordinator for the Grey Bruce Health More than 60 teens from Grey-Bruce, Niagara, Porcupine, Unit, which is an RNAO Best Practice Spotlight Organization (in Toronto, Thunder Bay and Timiskaming – handpicked by teachers, fact, most health units participating in this initiative are BPSOs). public health nurses, and others working in mental health – conIn the latter role, she oversees five schools in the area and supports verged on a sprawling retreat property in Caledon for two days in youth involved in the project to lead in-school activities that help to early November to develop strategies they could bring back and promote positive mental wellness and stigma reduction. She does share with peers in their own communities. Five members of the this by ensuring “super supportive” principals and teachers are group had already taken part in webinars, tasked with creating a aware of the project and on-board with students’ ideas. logo for the initiative. They unveiled their picks (created by youth) At JDSS, for example, students observe at the November meet-up, and particia “mindful minute” in some classrooms. pants voted on their favourite. This means there are two dedicated During the two-day event, teens were minutes of breathing and stretching encouraged to get their creative juices before class begins. Youth leads who flowing by doodling and playing with implemented this strategy introduced Play-Doh. A graffiti wall was created to the idea at an all-school assembly document “aha” moments, and a “chill Teens were tasked with creating a logo for the initiative, and meeting in December. They are hoping room” was provided to allow teens to at the November retreat, participants voted on their favourite. the initiative will take hold, particularly decompress if they found the discussions around exam time. Their goal is to about mental health overwhelming. have all classes participate in the exercise. Alicia Raimundo, a mental-health advocate and speaker for More than 40 students will be trained as leads during this school TEDx (part of a global speaking series), talked to the teens about year in Grey Bruce. They, in turn, will coach more peers. her own struggles with depression and anxiety, urging them to “They’re proud of their work,” says McCracken. “I’m passionate “…educate yourself, learn about mental health…and create an about making this continue.” environment for people (who are experiencing challenges) so they Anastasia Jaffray, 16, attends Toronto’s Michel Power/St. Joseph know they’re never alone.” High School. She was grateful to meet people from other parts of “You…are enough to change the world, and that is truly revoluOntario at the two-day training. “Mental health…affects everyone; tionary,” she said. it doesn’t matter how big or small your city is,” she says. “It’s nice Students were asked to document their challenges on paper pasted to the walls. They answered questions such as “how are stu- to see how many different schools got involved.” Brenagh Rapoport, 15, from Toronto’s Vaughan Road Academy, dents coping/why are students using substances?” Peer pressure, says the training resonated with her because members of her family escape, relationships, and exams were just some of the reasons and friends have struggled with their mental health. “You can take listed, and students spent the better part of an hour talking about the day off school if you have the flu, but if you have a panic attack, their own stressful experiences and coping strategies. you’re expected to be in school,” she says. “(Mental-health issues are) They were also asked to provide potential solutions to their seen as more trivial…as something you can deal with and move on.” stressors. Some ideas included: a puppy room; a breakfast pro“I definitely want to stay involved in the fight…against stigma, gram; and a chill room similar to the one provided at the training. (and to raise) awareness on mental-health issues,” Rapoport Students will try to determine if these ideas are feasible in their adds. “That’s something I’m very passionate about…(and) being own school communities. here for these two days has only reinforced that.” RN Tristen Dubois, 16, from New Liskeard (two hours north of North Bay), is hoping to open a booth at his school to help raise awareness of mental-health challenges. “People see mental health as a melissa di costanzo is staff writer at rnao. Registered nurse journal
23
A history of
diversity inclusivity In celebration of RNAO’s 90th anniversary – and to mark February as Black History Month – we take a look back at the association’s work on diversity, a matter that has shaped the profession from the mid-20th century to today. by Kimberley Kearsey
R
with cultural differences. “I just look at people as people…I just look NAO had only just celebrated two decades of at their behaviour,” she explains. “That interests me more than skin.” existence when black women in Canada were Hezekiah concurs, but acknowledges, as does Bailey, that finally allowed to go to school for nursing. It was discrimination was a reality for some of their colleagues. the late-1940s, and Jocelyn Hezekiah was too Nursing in this country “…has a history of excluding women of young to remember that time. She hadn’t yet colour,” claims Karen Flynn, author of Moving Beyond Borders and reached her tenth birthday, and wasn’t thinking an associate professor in the Department of Gender and Women’s about a career in nursing. Fast forward three decades and Hezekiah, who hails from Trinidad, would find herself Studies and the Department of African-American Studies Program at the University of Illinois. The book, pubat the helm of RNAO, the association’s first lished in 2012, details Bailey’s personal president to represent a cultural minority. story among others, and was described at She reflects on that time in her career and the time as “the first book-length history of remarks candidly that racism was not black health-care workers in Canada.” a pressing issue for RNAO in the late 70s. Flynn’s claim of exclusion resonates with “It may very well have been there, but it both Bailey and Hezekiah, who heard colwasn’t on the front burner,” she recalls. In leagues complain of being overlooked for fact, it wouldn’t come to the forefront for RN Emeritus Daphne Bailey (far right) studied nursing leadership roles. This was an issue that another decade. in the U.K. before coming to Canada in 1960. became very public in the early 1990s, when RN emeritus and former public health a group of seven black nurses at Toronto’s Northwestern General nurse Daphne Bailey, who, like Hezekiah, studied nursing and midHospital (now Humber River Regional Hospital) took their claims wifery in the U.K., arrived in Canada in 1960. She says she was of discrimination and exclusion to the Ontario Human Rights Com“lucky” to work for decades without feeling the direct impact of dismission (OHRC). The nurses said that “…access to professional crimination. Originally from Jamaica, Bailey was so happy to be in development and training, shift assignments, disciplinary actions the role she dreamed about as a child that she didn’t concern herself 24
January/February 2015
Jocelyn Hezekiah (left) was president-elect of RNAO in this image from the 1977 annual general meeting. Maureen Powers (centre) and Irmajean Bajnok (right) were executive director and president, respectively.
and promotions were based on racial factors, and that (Caucasian) nurses received preferential treatment,” according to historical documentation from the Ontario Nurses Association (ONA). They also complained the hospital had refused to support them when they were abused and harassed by patients and their families. In 1994, OHRC ruled in favour of the nurses and “…the hospital agreed to pay $320,000 and to take steps to ensure a racism-free workplace,” according to ONA. The ruling was a turning point in discussions about racism in the health-care sector, says Rani Srivastava, who was elected to RNAO’s board of directors in 2000. And “…it was a huge catalyst for me getting involved…” in the association, and eventually sitting on the board, she adds. When she heard then-RNAO President Kathleen MacMillan speak publicly about the case in 1994, and the need for health-care organizations to take a closer look at their processes with an anti-racism lens, Srivastava, whose cultural background is southeast Asian, remembers being pleased that an RNAO nursing leader was touching on an issue that she was very aware of on a personal level. “I would go to RNAO meetings and…people didn’t look like me,” Srivastava says. After the OHRC decision, provincial funding was allocated to create pilot projects that would tackle issues of racism. Hospitals, including The Wellesley Hospital, where Srivastava worked at the time, applied
for grants and launched anti-racism projects. Srivastava, now chief of nursing and professional practice at Toronto’s Centre for Addiction and Mental Health, knew she wanted to be a part of that change. She shared that desire with other RNs who were joining the board at the same time. Joan Lesmond was one of them. Originally from St. Lucia, Lesmond became the association’s second black president, not long after RNAO began its second century of existence. During her time – and as a top priority – RNAO formalized its anti-racism policy that was first drafted under MacMillan’s leadership in the late 90s. The board also worked to define what it truly means to respect diversity and to promote inclusivity. Gurjit Sangha, who was born in Canada but whose parents came from India, represented Region 6 on the board at that time, and recalls two important things about Lesmond’s legacy. The first was the anti-racism policy, which was formalized in 2002. The association committed to “…an environment where all nurses and clients are treated with dignity and respect, and where diversity is valued. We are committed to achieving an environment where all members of the profession have equal opportunities to participate fully in the nursing profession to their maximum potential…” “I think seeing her as leader of the organization made people think ‘how is it that RNAO can attract someone like Joan Lesmond?’” Sangha says, suggesting Lesmond’s presidency led Registered nurse journal
25
Former RNAO board members Rani Srivastava (left) and Gurjit Sangha (right) contributed their voices to diversity discussions that led to RNAO policies on racism and diversity.
Participation in World Pride festivities across Ontario, including Toronto’s Pride Parade, has become a tradition at RNAO. In 2014, CEO Doris Grinspun (centre, right) and associate director of nursing and health policy Tim Lenartowych (centre, left) don matching T-shirts alongside members with placards and a banner.
Former RNAO President Joan Lesmond (third from left) offered a keynote address at a Black Nurses Network Annual Dinner and Dance in 2006.
those guidelines have been cited over and over and over again… members who may not have felt represented to think “…there nobody else has that. And I think it’s fantastic.” must be something there that’s going to appeal to us and some“There’s such diversity in all of the communities where we work. thing important to us.” We want to…think about how culture impacts on people and famiRNAO is a reflection of what is going on in the broader commulies, how they make decisions and who they are as a family,” Sangha nity, Hezekiah suggests, and people started talking openly about says of the impetus for both the BPG and the Embracing Diversity diversity and inclusivity at the turn of the century. Lesmond, who Initiative. “It’s important for us to have an awareness of that and succumbed to cancer in 2011, was a trailblazer in this regard, and how we think about the nursing care we provide.” was keenly aware of the importance of having the profession of Acknowledging that discrimination is not only about race, RNAO nursing reflect the diversity of the population. began advocating against marginalization of other populations, and in In an interview before taking the helm, she told the Journal: particular, people who are transgender, including those who identify “Above all else, my fundamental belief in the basic value of respect as transsexual. In 2007, the Rainbow Nursing Interest Group (RNIG) for all people and a willingness to learn precedes all else and is the was formed to advance lesbian, gay, bisexual, and transgender (LGBT) foundation on which I will build my presidency.” inclusivity in education, research and the workplace. But the associaAnd she did build her presidency around just that. She led the tion’s work did not stop there. In fact, it continues today. launch of RNAO’s Embracing Diversity Initiative, suggesting that RNAO participates each year in festivities across the province to mark through that work, RNAO had an opportunity “…to show leadWorld Pride, including Toronto’s Pride Parade, and submissions to ership in a meaningful manner by…defining what diversity and government on issues of gender equality are ongoing. In 2012, the assoinclusivity mean in practical and symbolic terms.” She called on ciation presented to the standing committee on social policy regarding nurses to “…own this issue, and inform it.” Bill 33, Toby’s Act, which called for the right to be free from discrimi“Joan was a very public figure. She was out there. She talked about nation and harassment because of gender identity or gender expression. the issues,” Srivastava recalls. “She shared a lot of her own experiRNAO took a stand because all discrimination “…erodes health ences and challenged people’s view…she was a very powerful leader.” through increased risk of violence, poverty, and social exclusion, Thanks to the focused work of the board, RNAO released its diminishes access to health care, and threatens quality work enviOrganizational Statement on Diversity and Inclusivity in the spring ronments,” CEO Doris Grinspun told the committee. of 2007 that committed to “…providing an environment that is free “I think it’s fantastic we’re paying attention to gender and from racism, prejudice, discrimination and harassment. We strive sexual orientation…there’s lots of things that marginalize people to reflect the diverse communities within our organizational strucin groups,” Srivastava says, acknowledging RNAO is a reflection ture (board, staff members and students) and to promote equitable of what is going on around it. “I think the groups you focus on access to the programs and services we offer.” The association also change over time, but I think what you don’t want to lose sight released its Embracing Cultural Diversity best practice guideline of is the over-arching principles.” RNAO considers diversity and (BPG) that same year. inclusivity in so much of its work, Grinspun says, “I think that was amazing leadership from the Visit RNAO’s 90th and Srivastava agrees. “We haven’t lost that.” RN advisory group and RNAO to say…we will develop anniversary website at a guideline on embracing diversity in health care,” www.RNAO.ca/ninety Srivastava, who co-chaired the BPG, says. “I know kimberley kearsey is managing editor at rnao. 26
January/February 2015
one member
one Vote
March
31 TO
April
15
DO YOU KNOW A SPECIAL NURSE? Readers are being asked to nominate a Registered Nurse or Nurse Practitioner for the
Don’t forget to vote. Make your voice heard. RNAO members play a role in deciding important governance issues that affect the current and future direction of RNAO. Members decide who gets to sit on the association’s board of directors, and also vote on the selection of RNAO’s auditors, and more. You do this by voting (electronically).
14th ANNUAL TORONTO STAR NIGHTINGALE AWARD. Information on Award Criteria and where to send your nomination will be published in the Star and online at thestar.com/nightingale
Results of the voting will be announced at the annual general meeting (AGM) on April 17. The AGM will be divided into two sessions: the governance/business session will take place in the morning, and the membership consultation, to discuss the proposed resolutions, is scheduled for the afternoon. Consultation representatives will participate in the afternoon session.
Deadline for nominations is March 18, 2015. Award recipient and nominees will be announced during Nursing Week 2015.
One member, one vote will open online beginning at 12:00 noon (EST) on Tuesday, March 31. It closes at 12:00 (noon) on Wednesday, April 15. You can vote at any time during this voting period. To find out more, visit www.RNAO.ca/AGM2015
2015
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in the end
By adam morse
illustration: Aaron McConomy
What nursing means to me… As a nursing student, i viewed every new placement as an opportunity to test my skills, prove myself, and put my new-found knowledge into practice. I loved working beside experienced nurses. Just days into my first shift in an acute-care setting, I was 23 and ambitious. There was no challenge I could not conquer…at least that’s what I thought. I had yet to experience my first patient loss. On my third day, I was asked to observe a young man undergo a chest tube insertion. This was not common practice, particularly in a patient’s room on a respiratory unit, so I jumped at the opportunity. As the physicians began Drop us a line or two the procedure, I stood at the Tell us what nursing means to foot of the bed talking to you. Email editor@RNAO.ca the patient about sports and joking about the different teams we liked. As I talked, I noticed he had become silent. I stood frozen as his face became pale and he began to panic. He turned his gaze from me to those performing the insertion before rolling his head back and losing consciousness. The physician asked me to call a “Code Blue” to indicate cardiopulmonary arrest. I stepped out of the room and shouted to the surprise of others who don’t typically see this kind of emergency. Back in the room, a nurse had begun compressions. She turned to me and said: “You’re next. Get ready.” I was in absolute shock. I began repeating in my head everything I had learned, reminding myself “…this is what I prepared for. I can do this.” I took over the resuscitation efforts and felt my heart racing. Alarms were beeping and more people entered the room, each with their own task. 30
January/February 2015
Despite the chaos, I began to feel alone and panicked. As sweat began rolling down my face, a resident turned to me, his voice calm and soothing. He suggested I shift my hands slightly and told me I was doing a great job. In the same moment, a nurse tapped my back in encouragement, and let me know there were others to take over if I needed a break. In that moment, I knew I wasn’t alone. After what felt like hours, the young man was stabilized and escorted to the critical care and trauma centre. His heart stopped multiple times over a one-hour period, and he died. I stayed with him the entire time. It’s been two years since that placement experience and I am now an RN in a busy ER, where these codes occur frequently. I can say with confidence the support I received that day shaped the way I nurse. The reassurance made me feel as though I was no longer just a student on the unit, but an active member of the health-care team. That moment helped me realize why I got into nursing: to confidently care for patients and to encourage others to do the same, ultimately eradicating the stereotype that nurses eat their young. Today, I consistently reassure students and new grads they are doing well, and provide that same positive reinforcement I received. I answer questions and remain calm in times of panic, and in doing so, I hope to have the same positive influence on new nurses as others did on me when I was starting out. RN adam morse works in the er at london health sciences centre.
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